Tubercle最新文献

A 62-year-old male residing in Los Angeles, California, presented with a right upper lobe nodule associated with dry cough and weight loss. Mycobacterium asiaticum was isolated from sputum on two separate occasions. The patient was subsequently treated with four anti-tuberculous drugs, with bacteriologic conversion. This is the first report of pulmonary disease caused by M. asiaticum in the United States. The bacteriologic, immunologic and clinical aspects are reviewed.

A controlled study of three short-course regimens was undertaken in South Indian patients with newly diagnosed, sputum-positive pulmonary tuberculosis. The patients were allocated at random to one of three regimens: a) Rifampicin, streptomycin, isoniazid and pyrazinamide daily for 3 months (R3); b) the same regimen as above but followed by streptomycin, isoniazid and pyrazinamide twice-weekly for a further period of 2 months (R5); c) the same as R5 but without rifampicin (Z5). A bacteriological relapse requiring treatment occurred by 5 years in 16.8% of 113 R3,5.2% of 97 R5, and 20.0% of 115 Z5 patients with organisms sensitive to streptomycin and isoniazid initially. The differences in the relapse rates between the R3 and R5 regimens and the R5 and Z5 regimens were statistically significant (p < 0.01 for both). Considering patients with organisms initially resistant to streptomycin or isoniazid or both, 7 of 52 patients (4 R3, 2 R5,1 Z5) had a bacteriological relapse requiring retreatment.

A single step method for the digestion and decontamination of sputum for culture of tubercle bacilli is described. This method employs a transport medium containing tri-sodium phosphate and penicillin. Sputum samples are collected directly into the medium and, after standing overnight, deposits are inoculated onto Löwenstein-Jensen medium. The method was found to be superior to several other commonly used techniques and it avoids the problems of lengthy, multi-step procedures with associated risks of contamination from the atmosphere, costly reagents, the killing of tubercle bacilli by over-exposure to decontaminating agents, the unpleasantness of manipulating unprocessed sputum and the need for sophisticated equipment and special technical skills. The method is therefore ideal for use under the prevailing laboratory conditions in the developing countries.

A 69-year-old lady with previous medullary thyroid carcinoma treated by total thyroidectomy alone developed a swelling in the neck. This was thought to be a recurrence of her carcinoma but was found on investigation to be a tuberculous abscess of the thyroid bed. She was treated successfully by surgical drainage and antituberculous chemotherapy.

Two patients with pulmonary tuberculosis developed cutaneous vasculitis after antituberculosis treatment and a patient with tuberculous lymphadenitis developed vasculitis at presentation before drug therapy. The cutaneous vasculitis probably represented immunological reactions to tubercle bacilli and/or rifampicin with antibodies and immune complex formation.

In Agogo Hospital in the hills of Ashanti, Ghana, default and cure rates among 569 consecutive sputum-smear positive pulmonary tuberculosis (PTB) patients registered between 1984 and 1987 in a rural ambulatory non-supervised service program were analysed. Female gender, shorter home-to-clinic distances and younger age were significantly associated with higher cure and lower default rates. Within the district where liaison health workers paid home visits to PTB patients, the home-to-clinic distance effect on default was overruled by the effect of follow-up.

Data from two surveys held in 1985 and 1987, among 68 and 49 PTB patients respectively, revealed that many patients visited healing churches but few admitted to having consulted traditional healers; that financial expenses for transport outweighed hospital charges; that lower educational levels were not associated with poorer compliance to therapy and that health education had improved significantly over the 2-year-period. It is concluded that intervention with liaison health workers and simple health education results in improved outcome in rural service tuberculosis programme.

A study was undertaken to identify factors of prognostic importance for 199 Chinese children with tuberculous meningitis treated in Hong Kong between 1961 and 1984 inclusive. During the period under study rifampicin and then pyrazinamide were introduced into treatment regimens and intrathecal therapy was abandoned.

An analysis of pretreatment characteristics and details of chemotherapy by multivariate logistic regression identified two independent variables that predicted prognosis, namely clinical stage at the time of diagnosis, and age. Changes in treatment policies and the introduction of new anti-tuberculosis drugs did not appear to influence prognosis.

The frequency of sister chromatid exchanges was estimated in tuberculosis patients undergoing three different short term chemotherapy regimens (2SHRZ, 2HRZ and 2H₂R₂Z₂), to evaluate the possible genetic damage caused by anti-Tuberculous drugs. Of the three combinations studied, two combinations (2SHRZ and 2HRZ), which were administered daily, enhanced the frequency of sister chromatid exchanges significantly (p < 0.05), while the third bi-weekly combination 2H₂R₂Z₂), did not show any significant enhancement in the frequency of sister chromatid exchanges. These results are of importance in the treatment of tuberculosis, and indicate the need to select a drug combination that is equally efficient in the control of disease and at the same time less harmful to the genome of the patient.

Tuberculosis patients and healthy subjects from six ethnic groups of the Soviet Union were HLA-A, -B, -C, and DR typed. The frequencies of the HLA-A, -B and -C antigens differed amongst the ethnic groups. With all groups, however, patients with tuberculosis showed a significantly increased frequency of HLA-DR2 and a reduced frequency of HLADR3 type. Unfavourable dynamics of tuberculosis was significantly associated with an increased incidence of B15 and DR2 and a reduced incidence of B27 and DR3. Family studies revealed that the inheritance of susceptibility to tuberculosis (from parent to offspring) is associated with the inheritance of certain HLA haplotypes. Tuberculosis patients bearing the DR2 antigen had increased levels of IgG antibodies to PPD and the frequency of B7 and, more particularly, DR2 was higher in anergic patients.